IDCases
Obstructive nephropathy requiring dialysis secondary to genitourinary tuberculosis with concomitant pulmonary tuberculosis in an immunocompetent young adult: A case report
By Ghebremichael HT, Wakoya AD, Ayele MW and 2 others.
Abstract
Background
Genitourinary tuberculosis (GUTB) is a common form of extra-pulmonary tuberculosis that often presents with nonspecific urinary symptoms and is frequently diagnosed late. Genitourinary tuberculosis can cause progressive urinary tract obstruction, hydronephrosis, and renal impairment, particularly when diagnosis is delayed. Concurrent pulmonary involvement may occur and should be considered when evaluating patients with suspected genitourinary tuberculosis.
Case presentation
A 39-year-old male presented with a two-year history of progressive lower urinary tract symptoms,later accompanied by hematuria, constitutional symptoms, and altered mentation. Laboratory evaluation revealed severe anemia, elevated inflammatory markers, and progressive acute kidney injury. Abdominal CT demonstrated chronic right renal atrophy with left hydroureteronephrosis with ureteric wall thickening, asymmetric bladder wall thickening, and significant abdominopelvic lymphadenopathy. Urine GeneXpert MTB/RIF was positive for Mycobacterium tuberculosis. Chest radiography and HRCT confirmed concurrent active pulmonary tuberculosis with apical cavitary lesions and tree-in-bud nodules. The patient required hemodialysis for refractory hyperkalemia and uremic encephalopathy. After stabilization, renal-dose antituberculous therapy (RHZE) was initiated the patient showed progressive clinical and renal improvement. He was discharged and continued antituberculous therapy.